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|Do It Yourself Documents - |

|Bankruptcy Questionnaire |

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Process:

In order for us to process your paperwork, we will need you to complete this questionnaire. You should save this questionnaire to your desktop or somewhere on your computer that you can easily find. Once completed use our secure link located on the first page of this questionnaire or in the right column of each page of our website to upload your completed questionnaire. Or you may return it by fax, mail or drop it off at our office. We will review your questionnaire then call you with any questions and for payment.

Exemptions:

You will be required to select exemptions for property you want to protect that you list in the section “WORKSHEET: YOUR PROPERTY” located later in this questionnaire.

Debtors in the following states may select federal bankruptcy exemptions or use their state exemptions to protect their assets. 11 U.S.C. § 522. (Arkansas, Connecticut, District of Columbia, Hawaii, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, Pennsylvania, Rhode Island, Texas, Vermont, Washington, and Wisconsin.) Only you or an attorney may select exemptions to protect your assets. List of All state exemptions.

Credit Reports

Unless you know all of your creditors and their information, you will need a copy of your credit reports. By going to our Credit Reports webpage, you will find information to receive your credit reports free from three credit bureaus.

Credit Counseling

As per the Bankruptcy Reform Act of 2005, you are required to complete a prebankruptcy counseling session with an approved credit-counseling agency prior to filing. This is mandatory whether you file a Chapter 7 Bankruptcy or Chapter 13 Bankruptcy. You may use any approved credit-counseling agency. We recommend using GreenPath (866) 332-8435 or Consumer Credit Counseling Service (English 800-251-2227, en Espanola 866-672-2227) who will complete the entire counseling process in two sessions over the phone or online; however, if you find it difficult to get through to them use the link below to find an approved credit counseling agency in your area. You will receive a certificate of completion after your first session, which must be filed with the court when you file your petition.

List of Credit Counseling Agencies Approved Pursuant to 11 U.S.C. § 111

Understanding Bankruptcy

Bankruptcy BASICS provides basic information to debtors, creditors, court personnel, the media, and the general public on different aspects of the federal bankruptcy laws. It also provides individuals who may be considering bankruptcy with a basic explanation of the different chapters under which a bankruptcy case may be filed and to answer some of the most commonly asked questions about the bankruptcy process.

Select type of bankruptcy:

Presently, Chapter 13’s are only available with attorney option (Washington State only). Select one of each section:

1. (  ) Chapter 7

(  ) Chapter 13 (Washington State Only)

2. (  ) Paralegal option

(  ) Attorney option (Washington State Only)

3. (  ) Online Service

(  ) In-Office Service

Client Information Worksheets:

| |DEBTOR |JOINT DEBTOR |

|FULL NAME |      |      |

|STREET ADDRESS: |      |      |

|MAILING ADDRESS: |      |      |

|COUNTY: |      |      |

|HOME PHONE NUMBER: |      |      |

|WORK PHONE NUMBER: |      |      |

|FAX (if available) |      |      |

|EMAIL ADDRESS |      |      |

|SOC. SEC. NO.: |      |      |

|OTHER TAX IDS: |      |      |

|What other personal or business names have you used in the last eight (8) years? |

| |      |      |

| |      |      |

|How many people live in your household, including you, family members and all non-family members? |      |

Credit Counseling:

I/we have received approved budget and credit counseling during the 180-day period preceding the filing of this petition. Yes (  ) No (  )

Name of credit counseling agency      

Address of credit counseling agency      

I/we request a waiver of the requirement to obtain budget and credit counseling prior to filing based on exigent circumstances (Must attach certification describing.)

     

Prior Addresses:

Prior domicile (residence) within 730 days (County and State):

| |DEBTOR |JOINT DEBTOR |

|County: |      |      |

|State: |      |      |

|County: |      |      |

|State: |      |      |

Prior domicile (residence) within 180 days (County and State):

| |DEBTOR |JOINT DEBTOR |

|County: |      |      |

|State: |      |      |

|County: |      |      |

|State: |      |      |

Prior/Pending Bankruptcy Actions

PRIOR BANKRUPTCIES: If you have previously filed a bankruptcy petition, please list the case number, date, and the location where you filed on the lines following.

| |DEBTOR |JOINT DEBTOR |

|County: |      |      |

|State: |      |      |

|County: |      |      |

|State: |      |      |

PENDING BANKRUPTCIES: If any immediate family member or business partner has a bankruptcy pending, please list the case number, name of debtor, relation to you, date and location where filed, and the bankruptcy judge on the lines following.

| |DEBTOR |JOINT DEBTOR |

|County: |      |      |

|State: |      |      |

|County: |      |      |

|State: |      |      |

EXHIBIT "C" TO VOLUNTARY PETITION

If, to the best of the debtor's knowledge, the debtor owns or has possession of property that poses or is alleged to pose a threat of imminent and identifiable harm to the public health or safety, attach this Exhibit "C" to the petition.

Yes (  ) No (  ) Describe property:      

DEBTOR WHO RESIDES AS A TENANT OF RESIDENTIAL PROPERTY

Landlord has a judgment against the debtor for possession of debtor's residence. (If yes, complete the following). Yes (  ) No (  ) Name of landlord that obtained judgment:      

Address of landlord      

WORKSHEET: YOUR PROPERTY

Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites such as List of All state exemptions and statutes.

|Your Property |Who Owns It? |Market Value of |Your Ownership |Value of Liens |Amount of Equity |Exempt? If so, put |

|Provide detailed description |S – Single |Property? |Share (%, $) |(claims against | |exemption statute; |

|What is it? |H – Husband | | |property) | |if not write “No” |

|Where is it? |W – Wife | | | | |(Schedule C) |

| |J –Joint | | | | | |

| |C - Community | | | | | |

|Real Property is land and things permanently attached to land. Included are unimproved land, vacation cabins, condominiums, duplexes, rental property, business |

|property, mobile home park spaces, agricultural land, airplane hangars, and any other buildings permanently attached to land. It also includes property you are |

|entitled to by a trust and all property in which you have any legal, equitable, or future interest. If you are in a community property state, your spouse’s real |

|estate is also owned by you. (All leases and time shares should be listed on the worksheet for Schedule G.) |

|REAL ESTATE (Schedule A) |      |      |      |      |      |      |

|(Legal Desc. and Location) | | | | | | |

|      | | | | | | |

|REAL ESTATE (Schedule A) |      |      |      |      |      |      |

|(Legal Desc. and Location) | | | | | | |

|      | | | | | | |

|Personal Property (Schedule B) |      |      |      |      |      |      |

|1. Cash on hand. | | | | | | |

|2. Checking, savings, or other financial accounts, certificates of deposit, or shares in banks, savings and loan, thrift, building and loan, and homestead |

|associations, or credit unions, brokerage houses, or cooperatives. |

|      |      |      |      |      |      |      |

|      |      |      |      |      |      |      |

|      |      |      |      |      |      |      |

|3. Security deposits with public utilities, telephone companies, landlords, and others. |

|      |      |      |      |      |      |      |

|      |      |      |      |      |      |      |

|      |      |      |      |      |      |      |

|4. Household goods and furnishings, |      |      |      |      |      |      |

|including audio, video, and computer | | | | | | |

|equipment. | | | | | | |

|      | | | | | | |

Worksheet: Your Property continued:

Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites such as List of All state exemptions and statutes.

|Your Property |Who Owns It? |Market Value of |Your Ownership |Value of Liens |Amount of Equity |Exempt? If so, put |

|Provide detailed description |S – Single |Property? |Share (%, $) |(claims against | |exemption statute; |

|What is it? |H – Husband | | |property) | |if not write “No” |

|Where is it? |W – Wife | | | | |(Schedule C) |

| |J –Joint | | | | | |

| |C - Community | | | | | |

|5. Books, pictures, and other art objects,|      |      |      |      |      |      |

|antiques, stamp, coin, record, tape, | | | | | | |

|compact disk, and other collections or | | | | | | |

|collectibles. | | | | | | |

|      | | | | | | |

|6. Wearing apparel. |      |      |      |      |      |      |

|      | | | | | | |

|7. Furs and Jewelry. |      |      |      |      |      |      |

|      | | | | | | |

|8. Firearms and sports, photographic and |      |      |      |      |      |      |

|other hobby equipment. | | | | | | |

|      | | | | | | |

|9. Interests in insurance policies. Name |      |      |      |      |      |      |

|insurance company of each policy and | | | | | | |

|itemize surrender or refund value of each.| | | | | | |

|      | | | | | | |

|10. Annuities. Itemize and name each |      |      |      |      |      |      |

|issuer. | | | | | | |

|      | | | | | | |

Worksheet: Your Property continued:

Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites such as List of All state exemptions and statutes.

|Your Property |Who Owns It? |Market Value of |Your Ownership |Value of Liens |Amount of Equity |Exempt? If so, put |

|Provide detailed description |S – Single |Property? |Share (%, $) |(claims against | |exemption statute; |

|What is it? |H – Husband | | |property) | |if not write “No” |

|Where is it? |W – Wife | | | | |(Schedule C) |

| |J –Joint | | | | | |

| |C - Community | | | | | |

|11. Interests in an education IRA as |      |      |      |      |      |      |

|defined in 26 U.S.C. § 530(b)(1) or under | | | | | | |

|a qualified State tuition plan as defined | | | | | | |

|in 26 U.S.C. § 529(b)(1). Give | | | | | | |

|particulars. (File separately the | | | | | | |

|record(s) of any such interest(s). 11 | | | | | | |

|U.S.C. § 521(c); Rule 1007(b)). | | | | | | |

|      | | | | | | |

|12. Interests in IRA, ERISA, Keogh, or |      |      |      |      |      |      |

|other pension or profit sharing plans. | | | | | | |

|Give Particulars. | | | | | | |

|      | | | | | | |

|13. Stock and interests in incorporated |      |      |      |      |      |      |

|and unincorporated businesses. Itemize. | | | | | | |

|      | | | | | | |

|14. Interests in partnerships or joint |      |      |      |      |      |      |

|ventures. Itemize. | | | | | | |

|      | | | | | | |

|15. Government and corporate bonds and |      |      |      |      |      |      |

|other negotiable and nonnegotiable | | | | | | |

|instruments. | | | | | | |

|      | | | | | | |

|16. Accounts receivable |      |      |      |      |      |      |

|      | | | | | | |

Worksheet: Your Property continued:

Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites such as List of All state exemptions and statutes.

|Your Property |Who Owns It? |Market Value of |Your Ownership |Value of Liens |Amount of Equity |Exempt? If so, put |

|Provide detailed description |S – Single |Property? |Share (%, $) |(claims against | |exemption statute; |

|What is it? |H – Husband | | |property) | |if not write “No” |

|Where is it? |W – Wife | | | | |(Schedule C) |

| |J –Joint | | | | | |

| |C - Community | | | | | |

|17. Alimony, maintenance, support, and |      |      |      |      |      |      |

|property settlements to which the debtor | | | | | | |

|is or may be entitled. Give particulars. | | | | | | |

|      | | | | | | |

|18. Other liquidated debts owing debtor |      |      |      |      |      |      |

|including tax refunds. Give particulars. | | | | | | |

|      | | | | | | |

|19. Equitable or future interests, life |      |      |      |      |      |      |

|estates, and rights or powers exercisable | | | | | | |

|for the benefit of the debtor other than | | | | | | |

|those listed in Schedule A - Real | | | | | | |

|Property. | | | | | | |

|      | | | | | | |

|20. Contingent and noncontingent interests|      |      |      |      |      |      |

|in estate of a decedent, death benefit | | | | | | |

|plan, life insurance policy, or trust. | | | | | | |

|      | | | | | | |

|21. Other contingent and unliquidated |      |      |      |      |      |      |

|claims of every nature, including tax | | | | | | |

|refunds, counterclaims of the debtor, and | | | | | | |

|rights to setoff claims. Give estimated | | | | | | |

|value of each. | | | | | | |

|      | | | | | | |

|22. Patents, copyrights and other |      |      |      |      |      |      |

|intellectual property. Give particulars. | | | | | | |

|      | | | | | | |

Worksheet: Your Property continued:

Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites such as List of All state exemptions and statutes.

|Your Property |Who Owns It? |Market Value of |Your Ownership |Value of Liens |Amount of Equity |Exempt? If so, put |

|Provide detailed description |S – Single |Property? |Share (%, $) |(claims against | |exemption statute; |

|What is it? |H – Husband | | |property) | |if not write “No” |

|Where is it? |W – Wife | | | | |(Schedule C) |

| |J –Joint | | | | | |

| |C - Community | | | | | |

|23. Licenses, franchises and other general|      |      |      |      |      |      |

|intangibles. Give particulars. | | | | | | |

|      | | | | | | |

|24. Customer lists or other compilations |      |      |      |      |      |      |

|containing personally identifiable | | | | | | |

|information (as defined in 11 U.S.C. § | | | | | | |

|101(41A)) in customer lists or similar | | | | | | |

|compilations provided to the debtor by | | | | | | |

|individuals in connection with obtaining a| | | | | | |

|product or service from the debtor | | | | | | |

|primarily for personal, family, or | | | | | | |

|household purposes. | | | | | | |

|      | | | | | | |

|25. Automobiles, trucks, trailers and |      |      |      |      |      |      |

|other vehicles and accessories. | | | | | | |

|      | | | | | | |

|26. Boats, motors, and accessories. |      |      |      |      |      |      |

|      | | | | | | |

|27. Aircraft and accessories. |      |      |      |      |      |      |

|      | | | | | | |

|28. Office equipment, furnishings and |      |      |      |      |      |      |

|supplies. | | | | | | |

|      | | | | | | |

Worksheet: Your Property continued:

Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites such as List of All state exemptions and statutes.

|Your Property |Who Owns It? |Market Value of |Your Ownership |Value of Liens |Amount of Equity |Exempt? If so, put |

|Provide detailed description |S – Single |Property? |Share (%, $) |(claims against | |exemption statute; |

|What is it? |H – Husband | | |property) | |if not write “No” |

|Where is it? |W – Wife | | | | |(Schedule C) |

| |J –Joint | | | | | |

| |C - Community | | | | | |

|29. Machinery, fixtures, equipment and |      |      |      |      |      |      |

|supplies used in business. | | | | | | |

|      | | | | | | |

|30. Inventory. |      |      |      |      |      |      |

|      | | | | | | |

|31. Animals. |      |      |      |      |      |      |

|      | | | | | | |

|32. Crops- growing or harvested. Give |      |      |      |      |      |      |

|particulars. | | | | | | |

|      | | | | | | |

|33. Farming equipment and implements. |      |      |      |      |      |      |

|      | | | | | | |

|34. Farm supplies, chemicals and feed. |      |      |      |      |      |      |

|      | | | | | | |

|35. Other personal property of any kind |      |      |      |      |      |      |

|not already listed. Itemize. | | | | | | |

|      | | | | | | |

WORKSHEET: YOUR DEBTS - Secured – Schedule D

|Creditor’s |Who Owns It? |Account No. and Date |Describe Debt |Balance Owed |Others Involved |

|Name and Address |S – Single |Incurred | | |Name and Address |

| |H – Husband | | | |(i.e. Collection Agency, Co |

| |W – Wife | | | |debtor, etc.) |

| |J –Joint | | | | |

| |C - Community | | | | |

|Mortgage(s) on Principal Res. |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|Mortgage(s) on Principal Res. |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|Automobile Loans |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|Automobile Loans |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|List Other Secured Debts Below: |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

WORKSHEET: YOUR DEBTS - Priority – Schedule E

|Creditor’s |Who Owns It? |Desc. Tax Due |Describe Debt |Balance Owed |Others Involved |

|Name and Address |S – Single | | | |Name and Address |

| |H – Husband | | | |(i.e. Collection Agency, Co |

| |W – Wife | | | |debtor, etc.) |

| |J –Joint | | | | |

| |C - Community | | | | |

|FEDERAL TAXES |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|FEDERAL TAXES |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|FEDERAL TAXES |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|STATE TAXES |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|STATE TAXES |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|Creditor’s |Desc. of Support Due |Monthly Payment |Balance Owed |

|Name and Address | | | |

|Child Support |      |      |      |

|      | | | |

|Child Support |      |      |      |

|      | | | |

|Child Support |      |      |      |

|      | | | |

|Spousal Maintenance |      |      |      |

|      | | | |

WORKSHEET: YOUR DEBTS - Unsecured – Schedule F

Secured debts are car loans, home loans, home equity loans, second mortgages, or any other loans where property is pledged as security. All other types of debt are unsecured.

|Creditor’s |Who Owns It? |Account No. and Date |Describe Debt |Balance Owed |Others Involved |

|Name and Address |S – Single |Incurred | | |Name and Address |

| |H – Husband | | | |(i.e. Collection Agency, Co |

| |W – Wife | | | |debtor, etc.) |

| |J –Joint | | | | |

| |C - Community | | | | |

|List all Unsecured Debts Below: |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      | Collection Agency |

| | | | | |Co debtor |

| | | | | |Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

WORKSHEET: YOUR DEBTS - Unsecured – Schedule F, cont.

Secured debts are car loans, home loans, home equity loans, second mortgages, or any other loans where property is pledged as security. All other types of debt are unsecured.

|Creditor’s |Who Owns It? |Account No. and Date |Describe Debt |Balance Owed |Others Involved |

|Name and Address |S – Single |Incurred | | |Name and Address |

| |H – Husband | | | |(i.e. Collection Agency, Co |

| |W – Wife | | | |debtor, etc.) |

| |J –Joint | | | | |

| |C - Community | | | | |

|List all Unsecured Debts Below: |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      | | | | | |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

|      |      |      |      |      |() Collection Agency |

| | | | | |() Co debtor |

| | | | | |() Other |

| | | | | |      |

WORKSHEET: Leases/Contracts - Schedule G

LEASES OR CONTRACTS: Are you a party to any leases or contracts? If you owe money on these contracts, they should be listed on the Schedules above.

Yes (  ) No (  )

If yes, list the parties involved and their addresses.

     

WORKSHEET: - Schedule I

| |DEBTOR |JOINT DEBTOR |

|MARITAL STATUS: |(  ) Single (  ) Married (Living Together) (  ) Married (Living Apart) |

| |(  ) Divorced (  ) Legal Separation |

|AGE: |      |      |

|OCCUPATION: |      |      |

|LENGTH OF EMP.: |      |      |

|EMPLOYER NAME: |      |      |

|WORK PHONE NUMBER: |      |      |

|EMPLOYER ADDRESS: |      |      |

WORKSHEET: - Schedule I, cont.

Dependents:

|NAME |AGE |RELATIONSHIP |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

|      |      |      |

Your Income:

| |DEBTOR |JOINT DEBTOR |

|Current monthly gross wages, salary, commissions (Pro-rate if not paid monthly) |      |      |

|Estimated monthly overtime |      |      |

|Payroll Taxes and Social Security Deducted |      |      |

|Insurance Deducted |      |      |

|Union dues Deducted |      |      |

|Other payroll deductions- specify |      |      |

|Regular monthly income from business, profession, or farm (Attach a detail statement) |      |      |

|Monthly income from real property |      |      |

|Monthly interest and dividends |      |      |

|Alimony, maintenance, or support payments (amount received monthly for debtor’s or debtor’s |      |      |

|dependents’ use) | | |

|Social Security or government assistance |      |      |

|Pension or retirement |      |      |

|Other monthly income |      |      |

|Describe any increase or decrease of more than 10% in any previous category anticipated to occur |      |      |

|in the year following this filing. | | |

WORKSHEET: - Schedule I, cont.

STATEMENT OF MONTHLY NET INCOME

|INCOME: |DEBTOR |JOINT DEBTOR |

|SIX MONTHS AGO |      |      |

|FIVE MONTHS AGO |      |      |

|FOUR MONTHS AGO |      |      |

|THREE MONTHS AGO |      |      |

|TWO MONTHS AGO |      |      |

|LAST MONTH AGO |      |      |

|INCOME FROM OTHER SOURCES |      |      |

|TOTAL NET INCOME FOR SIX MONTHS PRECEDING FILING |      |      |

WORKSHEET: - Schedule J

Your Expenses

| |DEBTOR(S) |

|Rent or home mortgage payment? Rent (  ) Mortgage (  ) |      |

|Does this include real estate taxes? Yes (  ) No (  ) | |

|Does this include property insurance? Yes (  ) No (  ) | |

|Electricity and heating fuel (average monthly) |      |

|Water and sewer (average monthly) |      |

|Telephone (average monthly) |      |

|Other utilities (average monthly) |      |

|Home maintenance (repairs and upkeep) |      |

|Food |      |

|Clothing |      |

|Laundry and dry cleaning |      |

|Medical and dental expenses |      |

|Transportation (not including car payments) |      |

|Recreation, clubs and entertainment, newspapers, etc. |      |

|Charitable contributions |      |

|Homeowner’s or renter’s insurance |      |

|Life insurance |      |

|Health insurance |      |

|Auto insurance |      |

|Other insurance – specify       |      |

|Taxes not deducted from wages or in home mortgage payments |      |

|Installment auto payments |      |

|Other installment payments not included in Chapter 13 Plan |      |

|Alimony, maintenance, and support paid to others |      |

|Payments for dependents not living at your home |      |

|Operation expenses of business, profession, or farm |      |

|Other expenses       |      |

|Other expenses       |      |

|Other expenses       |      |

|Describe any increase or decrease in expenditures reasonably anticipate to occur within the year following the filing of this |      |

|document.       | |

FORM 7: Statement of Financial Affairs

Numbers correspond to Form 7’s questions:

1. Income from employment or operation of business. Enter each income source for the past two years. Specify the amount of income and the fiscal year.

|Sources (name and address) |Amount |Fiscal Period |

|      |      |      |

|      |      |      |

2. Income other than from employment or operation of business. Enter sources of any other income during the past two years. Specify the amount of income and the fiscal year.

|Sources (name and address) |Amount |Fiscal Period |

|      |      |      |

|      |      |      |

3.

a. Individual or joint debtor(s) with primarily consumer debts: List payments made to any creditor during the last 90 days.

|Creditors |Dates of |Amount |Amount |

|(name and address) |Payments |Paid |Still Owing |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

b. Debtor whose debts are not primarily consumer debts: List payments made to any creditor during the last 90 days.

|Creditors |Dates of |Amount |Amount |

|(name and address) |Payments/Transfers |Paid |Still Owing |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

c. List payments made to insider creditors during the last year.

|Creditors |Dates of |Amount |Amount |

|(name and address) |Payments |Paid |Still Owing |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

4.

a. Were you sued or did you sue anybody last year (12 months)? Yes (  ) No(  ) if yes, list the following in an email, text file or by fax: caption of suit, case number, nature of proceeding, court and location, status/disposition; and attorney representing.

b. Status/disposition; and attorney representing.

|Creditors |Date of |Description and |

|(name and address) |Seizure |Value of property |

|      |      |      |

|      |      |      |

5. List any repossessions, foreclosures and voluntary returns during the last year.

|Assignee |Date of |Description and |

|(name and address) |repossession |Value of property |

|      |      |      |

|      |      |      |

6.

a. Describe any assignment of property for the benefit of creditors made within the last 120 days.

|Creditors |Date of |Terms of |

|(name and address) |Assignment |Assignment or Settlement |

|      |      |      |

|      |      |      |

b. List all property which has been in the hands of a custodian, receiver, or court-appointed official during the past year.

|Custodian |Date of |Name Location Of Court |Description and |

|(name and address) |Order |& Case Title and Number |Value of Property |

|      |      | |      |

|      |      | |      |

7. List all gifts or charitable contributions made during the last year except ordinary and usual gifts to family members totaling less than $200 per family member and $100 per charitable recipient.

|Recipient |Date of |Relationship |Description and |

|(name and address) |Gift |(if any) |Value of Gift |

|      |      |      |      |

|      |      |      |      |

8. List all losses from fire, theft, other casualty or gambling during the past year

|Description |Date of |Was Loss Covered |Value of |

|Of Property |Loss |By insurance |Property |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

9. List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultation concerning debt consolidation, relief under the bankruptcy law or preparation of a petition in bankruptcy during the past year.

|Payee |Date of Payment, |Amount Paid or |

|(name and address) |Payor |Value of property transferred |

|      |      |      |

|      |      |      |

10.

a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of the debtor, transferred either absolutely or as security during the past two years to creditor or family member.

|Transferee & relationship |Date |Describe property transferred |

|(name and address) | |And value received |

|      |      |      |

|      |      |      |

b. List all other property transferred by the debtor during the past ten years to a self settled trust or similar device of which the debtor is a beneficiary.

|Trust or other device |Date |Amount of money or value of property or debtor's |

|(name) | |interest in property |

|      |      |      |

|      |      |      |

11. List all financial accounts and instruments held by or for the benefit of the debtor which were closed, sold or otherwise transferred in the past year. Include checking, savings, or other financial accounts, CDs, shares and share accounts held in banks, credit unions, pension funds, brokerage houses, etc.

|Institution |Acct type & number |Amount & date of |

|(name and address) |Amt of Final Balance |sale or closing |

|      |      |      |

|      |      |      |

12. List each safe deposit or other box or depository in which you have had valuables within the past year.

|Institution |Date of transfer or |Who has access? |Description of |

|(name and address) |surrender |(name and address |Contents |

|      |      |      |      |

|      |      |      |      |

13. List all setoffs (money taken from an account to repay a loan at the same bank as where your money has been deposited) made by any creditor, including a bank, against a debt of the debtor within the past 90 days.

|Creditor |Date of |Amount of |

|(name and address) |Setoff |Setoff |

|      |      |      |

|      |      |      |

14. List all property OWNED by another person or entity that the debtor (you or you and your spouse) holds or controls.

|Owner |Description & Value |Location of |

|(name and address) |Of Property |Property |

|      |      |      |

|      |      |      |

15. If the debtor has moved within the last THREE years, list all premises occupied and vacated during that period.

|Address |Name Used |Dates of Occupancy |

|      |      |      -       |

|      |      |      -       |

16. Identify the name of debtor's spouse or former spouse who resided with the debtor in a community property state in the EIGHT years immediately preceding the commencement of the case.

|Name |

|      |

|      |

17.

a. List the name and address of every site for which the corporation has received notice in writing by a governmental unit that the corporation may be liable or potentially liable under or in violation of an Environmental Law.

"Environmental Law" means any federal, state or local statute or regulation regulating pollution, contamination, releases of hazardous or toxic substances, wastes or material into the air, land, soil, surface water, groundwater, or other medium, including, but not limited to, statutes or regulations regulating the cleanup of these substances, wastes, or material.

"Site" means any location, facility, or property as defined under any Environmental Law, whether or not presently or formerly owned or operated by you, including, but not limited to, disposal sites.

"Hazardous Material" means anything defined as a hazardous waste, hazardous substance, toxic substance, hazardous material, pollutant, or contaminant or similar term under an Environmental Law.

Indicate the governmental unit, the date of the notice, and if known, the Environmental Law:

|Site |Date of Notice |Name and Address of Government Unit |Environmental Law |

|(name and address) | | | |

|      |      |      |      |

|      |      |      |      |

b. List the name and address of every site for which you provided notice to a governmental unit of a release of Hazardous Material. Indicate the governmental unit to which the notice was sent and the date of the notice.

|Site |Date of Notice |Name and Address of Government Unit |Environmental Law |

|(name and address) | | | |

|      |      |      |      |

|      |      |      |      |

c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with respect to which you are or were a party. Indicate the name and address of the governmental unit that is or was a party to the proceeding, and the docket number.

|Name and Address of |Docket Number |Status of Disposition |

|Government Unit | | |

|      |      |      |

|      |      |      |

18. If you are an individual, list the names, addresses, taxpayer identification numbers, nature of the business, and beginning and ending dates of all businesses in which you were an officer, director, partner, or managing executive of a corporation, partnership, sole proprietorship, or were a self-employed professional within the last six years, or in which you owned 5 percent or more of the voting or equity securities within the last six years.

If you are a partnership, list the names, addresses, taxpayer identification numbers, nature of the business, and beginning and ending dates of all businesses in which you were a partner or owned 5 percent or more of the voting or equity securities, within the last six years.

If you are a corporation, list the names, addresses, taxpayer identification numbers, nature of the business, and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities within the last six years.

|Name |Last four digits of Soc. Sec. |Address |Nature of Business |Beginning and Ending Dates |

| |No./Complete EIN or other | | | |

| |taxpayer I.D. No. | | | |

|      |      |      |      |      –       |

|      |      |      |      |      -       |

Identify any business listed above that is "single asset real estate."

|Name |Address |

|      |      |

|      |      |

NOTICE TO INDIVIDUAL CONSUMER DEBTOR UNDER § 342(b)

The following two pages must be read by the Debtor & Co-Debtor and signed and dated by both. You will need to print these two pages return them to us prior to us completing your documents. If you are using our in-office services you may bring them to your appointment. If you are using our online service you will need to mail them, scan them back to your computer and email them, or fax them.

Mailing address:

1819 South Commons

The Commons Mall

Federal Way, WA 98003

FAX Number: (888) 377-2397

UNITED STATES BANKRUPTCY COURT

NOTICE TO CONSUMER DEBTOR(S) UNDER §342(b) OF THE BANKRUPTCY CODE

In accordance with § 342(b) of the Bankruptcy Code, this notice to individuals with primarily consumer debts: (1) Describes briefly the services available from credit counseling services; (2) Describes briefly the purposes, benefits and costs of the four types of bankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and notifies you that the Attorney General may examine all information you supply in connection with a bankruptcy case.

You are cautioned that bankruptcy law is complicated and not easily described. Thus, you may wish to seek the advice of an attorney to learn of your rights and responsibilities should you decide to file a petition. Court employees cannot give you legal advice.

Notices from the bankruptcy court are sent to the mailing address you list on your bankruptcy petition. In order to ensure that you receive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the court of any changes in your address. If you are filing a joint case (a single bankruptcy case for two individuals married to each other), and each spouse lists the same mailing address on the bankruptcy petition, you and your spouse will generally receive a single copy of each notice mailed from the bankruptcy court in a jointly- addressed envelope, unless you file a statement with the court requesting that each spouse receive a separate copy of all notices.

1. Services Available from Credit Counseling Agencies

With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for bankruptcy relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit counseling and provides assistance in performing a budget analysis. The briefing must be given within 180 days before the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by telephone or on the Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the United States trustee or bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the approved budget and credit counseling agencies. Each debtor in a joint case must complete the briefing.

In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial management instructional course before he or she can receive a discharge. The clerk also has a list of approved financial management instructional courses. Each debtor in a joint case must complete the course.

2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer Debtors

Chapter 7: Liquidation ($245 filing fee, $46 administrative fee, $15 trustee surcharge: Total fee $306)

Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtors whose debts are primarily consumer debts are subject to a “means test” designed to determine whether the case should be permitted to proceed under chapter 7. If your income is greater than the median income for your state of residence and family size, in some cases, the United States trustee (or bankruptcy administrator), the trustee, or creditors have the right to file a motion requesting that the court dismiss your case under § 707(b) of the Code. It is up to the court to decide whether the case should be dismissed.

Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to take possession of and sell the remaining property that is not exempt and use the sale proceeds to pay your creditors.

The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to have committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny

Form B 201A, Notice to Consumer Debtor(s) Page 2

your discharge and, if it does, the purpose for which you filed the bankruptcy petition will be defeated.

Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still be responsible for most taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support and property settlement obligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts which are not properly listed in your bankruptcy papers; and debts for death or personal injury caused

by operating a motor vehicle, vessel, or aircraft while intoxicated from alcohol or drugs. Also, if a creditor can prove that a debt arose from fraud, breach of fiduciary duty, or theft, or from a willful and malicious injury, the bankruptcy court may determine that the debt is not discharged.

Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee, $46 administrative fee: Total fee $281)

Chapter 13 is designed for individuals with regular income who would like to pay all or part of

their debts in installments over a period of time. You are only eligible for chapter 13 if your debts do not exceed certain dollar amounts set forth in the Bankruptcy Code.

Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them, using your future earnings. The period allowed by the court to repay your debts may be three years or

five years, depending upon your income and other factors. The court must approve your plan before it can take effect.

After completing the payments under your plan, your debts are generally discharged except for domestic support obligations; most student loans; certain taxes; most criminal fines and restitution obligations; certain debts which are not properly listed in your bankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term secured obligations.

Chapter 11: Reorganization ($1000 filing fee, $46 administrative fee: Total fee $1046)

Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions are quite complicated, and any decision by an individual to file a chapter 11 petition should be reviewed with an attorney.

Chapter 12: Family Farmer or Fisherman ($200 filing fee, $46 administrative fee: Total fee $246)

Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from future earnings and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those

whose income arises primarily from a family-owned farm or commercial fishing operation.

3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials

A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of perjury, either orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All information supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General acting through the Office of the United States Trustee, the Office of the United States Attorney, and other components and employees of the Department of Justice.

WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your creditors, assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if this information is not filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and the local rules of the court. The documents and the deadlines for filing them are listed on Form B200, which is posted at .

Signature of Debtor (date)

Signature of Co-Debtor (date)

Agreement with Do It Yourself Documents

This is an agreement between us:

Do It Yourself Documents, LLC and you, if you choose to use our services. It contains the basic terms of our agreement to provide you with document preparation assistance so that you can better represent yourself in your Chapter 7 or 13 Bankruptcy case.

Scope of Legal Advice:

Absolutely none. We are not attorneys and cannot nor will give legal advice. This questionnaire follows the software program used by Do It Yourself Documents, LLC.

Duration of Document Help:

Our agreement to prepare your bankruptcy documents begins immediately upon our receipt of the questionnaire and payment for the service you require and will end at the completion of you receiving all of your bankruptcy petition documents.

Cooperation:

To prepare your documents effectively, we need all information requested within the questionnaire. You must agree to answer any questions we ask either in the following questionnaire or by follow up telephone conference.

Costs:

There are costs that are part of filing a chapter 7 & 13 bankruptcy petition with the courts and costs for credit counseling. We will not pay any costs in your case. Rather, you will be responsible for all costs.

Privacy Policy:

Your privacy is of great importance to us and our questionnaires collect highly sensitive information. You are valued by us and we will take appropriate measures to protect the information collected from you on this site. Everything is considered confidential and will never be released to any third party. We only request information absolutely essential to respond to your requests on our products and services.

The following rules govern us and all independent paralegals and explain your recourse if you believe your rights were violated.

Additional Rules governing Bankruptcy Preparers as per the Department of Justice

BANKRUPTCY PETITION PREPARERS

HERE IS WHAT YOU SHOULD KNOW IF YOU USE A TYPING SERVICE, PARALEGAL, OR DOCUMENT PREPARATION SERVICE TO HELP YOU FILE YOUR BANKRUPTCY

Bankruptcy is a legal proceeding controlled by federal law. As a debtor in bankruptcy, you may retain an attorney to represent you or you may represent yourself without an attorney. You may also go to a bankruptcy petition preparer, sometimes called a "typing service" or "paralegal."

Federal law controls the services rendered by bankruptcy petition preparers. The law is designed to protect debtors as consumers of these services. If you use a bankruptcy petition preparer to assist you in preparing your bankruptcy documents, you should be familiar with your rights and their duties.

What is a bankruptcy petition preparer?

A "bankruptcy petition preparer" means a person, other than an attorney or an employee of an attorney, who prepares for a fee, a document for filing by the debtor in the United States Bankruptcy Court.

What may a bankruptcy petition preparer not do?

Bankruptcy petition preparers are not attorneys. Even the bankruptcy petition preparers who call themselves "paralegals" are not usually supervised by an attorney. They may not represent debtors in any bankruptcy proceeding and they may not give debtors any legal advice.

Legal advice includes:

• Telling you which type of bankruptcy to file;

• Telling you not to list certain debts;

• Telling you not to list certain assets;

• Telling you what property to exempt.

Bankruptcy petition preparers may only type bankruptcy documents and must only charge a reasonable fee. A bankruptcy petition preparer may not sign any bankruptcy document on your behalf. As the debtor, you must personally sign the bankruptcy documents. A bankruptcy petition preparer may not collect, receive, or handle the court fees in connections with your bankruptcy case. That means that the bankruptcy petition preparer cannot accept from you, or another person on your behalf, any money in any form (i.e., cash, check, or money order) to pay your bankruptcy filing fees or other court fees. A bankruptcy petition preparer is prohibited from advertising using the word "legal" or any similar term, and may not advertise under any category that includes the word "legal" or any similar term. This is to prevent bankruptcy petition preparers from misleading the public or a debtor into believing that the bankruptcy petition preparer is authorized to practice or otherwise give legal advice.

What must a bankruptcy petition preparer do for a debtor?

If a bankruptcy petition preparer prepares a document for you for filing in your bankruptcy case, the bankruptcy petition preparer must sign the document and print on the document the preparer's name, address, and Social Security account number. A bankruptcy petition preparer must provide you with a complete copy of the bankruptcy documents which he or she prepared for you, not later than the time when you sign the documents. A bankruptcy petition preparer must file with the bankruptcy court a declaration signed under penalty of perjury disclosing any fee or compensation received from you, or any person on your behalf, for preparing your bankruptcy documents, and the amount of any fees still owing. The bankruptcy petition preparer must file this declaration with the court not later then ten days after the filing of your bankruptcy petition.

What can you do if a bankruptcy petition preparer causes you legal or economic injury?

If your bankruptcy case is dismissed because the bankruptcy petition preparer acted negligently or with intentional disregard for the Bankruptcy Code and Federal Rules of Bankruptcy Procedure, or if the bankruptcy petition preparer committed any fraud, unfair or deceptive act which cause you damage, then you may have the right to ask the court to order the bankruptcy petition preparer to pay:

(a) your actual damages;

(b) the greater of -

(i) $2,000; or

(ii) twice the amount paid to the bankruptcy petition preparer for the preparer's services; and

(c) your attorney's reasonable fees and costs for bringing the motion to recover damages.

If the bankruptcy petition preparer charged you an reasonably high fee for typing bankruptcy documents, you may request that the court review the reasonableness of the fees. If the court determines that the fees charged were excessive, the court may order the bankruptcy petition preparer to refund to you all or a portion of the fees you paid.

ADMONITION

As a debtor in bankruptcy, you have rights and obligation defined by law. The choices you make when completing your bankruptcy documents, and throughout your bankruptcy, will have significant, serious, and long term legal and practical consequences. If you have questions regarding your legal rights and responsibilities, we urge you to consult with an attorney immediately. Bankruptcy is a civil proceeding and there is no right to free legal counsel. However, if you cannot afford to consult an attorney, your local Legal Aid Society may be able to provide you with free or affordable legal counsel.

If you believe that your rights have been violated or that a bankruptcy petition preparer failed to comply with the law, you may wish to contact an attorney, your bankruptcy trustee, or the United States Trustee.

You must accept these terms to download the questionnaire; however, you are not bound in any way to use our services.

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